Provider Demographics
NPI:1891316964
Name:CRIDER, JENNIFER A (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:CRIDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4985 BLACKSMITH PATH
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4703
Mailing Address - Country:US
Mailing Address - Phone:315-944-0379
Mailing Address - Fax:
Practice Address - Street 1:135 OLD COVE RD STE 208
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-3775
Practice Address - Country:US
Practice Address - Phone:315-944-0379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32856101YA0400X
NY0903741041C0700X
NY101607104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty